Lutz Stösser

Protective influence of experimentally formed salivary pellicle on enamel erosion. An in vitro study.

The purpose of this study was to evaluate dental erosion in 0.1 and 1.0% citric acid in vitro by several different methods and to assess the protective potential of experimentally formed salivary pellicle (24 h in vitro). Bovine enamel slabs were embedded in epoxy resin and polished. Erosion was performed in citric acid for 1, 5 or 10 min and recorded as microhardness loss, as changes of surface roughness (Ra, Rt and RzDIN) and as calcium release. Additionally, erosive alterations were observed with scanning electron microscopy. Significant microhardness loss on non-pellicle-covered specimens was measured after 1-min exposure to 0.1% citric acid. Microhardness loss was time- and concentration-dependent. Salivary pellicle significantly inhibited both microhardness loss, except after 10-min immersion in 1.0% citric acid, and significantly reduced the increase of surface roughness. There were, however, no significant differences in calcium release between pellicle-covered and non-covered enamel. The results support the general conclusion that salivary pellicle effectively protects enamel surface against short-term erosion in organic acids.

Comparison of the efficacies of disinfectants to control microbial contamination in dental unit water systems in general dental practices across the European union

ABSTRACT Water delivered by dental unit water systems (DUWS) in general dental practices can harbor high numbers of bacteria, including opportunistic pathogens. Biofilms on tubing within DUWS provide a reservoir for microorganisms and should be controlled. This study compared disinfection products for their ability to meet the American Dental Associations guideline of <200 CFU · ml−1 for DUWS water. Alpron, BioBlue, Dentosept, Oxygenal, Sanosil, Sterilex Ultra, and Ster4Spray were tested in DUWS (n = 134) in Denmark, Germany, Greece, Ireland, The Netherlands, Spain, and the United Kingdom. Weekly water samples were tested for total viable counts (TVCs) on yeast extract agar, and, where possible, the effects of products on established biofilm (TVCs) were measured. A 4- to 5-week baseline measurement period was followed by 6 to 8 weeks of disinfection (intermittent or continuous product application). DUWS water TVCs before disinfection ranged from 0 to 5.41 log CFU · ml−1. Disinfectants achieved reductions in the median water TVC ranging from 0.69 (Ster4Spray) to 3.11 (Dentosept) log CFU · ml−1, although occasional high values (up to 4.88 log CFU · ml−1) occurred with all products. Before treatment, 64% of all baseline samples exceeded American Dental Association guidelines, compared to only 17% following commencement of treatment; where tested, biofilm TVCs were reduced to below detectable levels. The antimicrobial efficacies of products varied (e.g., 91% of water samples from DUWS treated with Dentosept or Oxygenal met American Dental Association guidelines, compared to 60% of those treated with Ster4Spray). Overall, the continuously applied products performed better than those applied intermittently. The most effective products were Dentosept and Oxygenal, although Dentosept gave the most consistent and sustained antimicrobial effect over time.

Effects of Dental Probing on Occlusal Surfaces – A Scanning Electron Microscopy Evaluation

The aim of this clinical-morphological study was to investigate the effects of dental probing on occlusal surfaces by scanning electron microscopy (SEM). Twenty sound occlusal surfaces of third molars and 20 teeth with initial carious lesions of 17- to 26-year-old patients (n = 18) were involved. Ten molars of each group were probed with a sharp dental probe (No. 23) before extraction; the other molars served as negative controls. After extraction of the teeth, the crowns were separated and prepared for the SEM study. Probing-related surface defects, enlargements and break-offs of occlusal pits and fissures were observed on all occlusal surfaces with initial carious lesions and on 2 sound surfaces, respectively. No traumatic defects whatsoever were visible on unprobed occlusal surfaces. This investigation confirms findings of light-microscopic studies that using a sharp dental probe for occlusal caries detection causes enamel defects. Therefore, dental probing should be considered as an inappropriate procedure and should be replaced by a meticulous visual inspection. Critical views of tactile caries detection methods with a sharp dental probe as a diagnostic tool seem to be inevitable in undergraduate and postgraduate dental education programmes.

In vivo detection of non-cavitated caries lesions on occlusal surfaces by visual inspection and quantitative light-induced fluorescence.

Objective. The aim of this clinical caries detection study was to compare the outcome of quantitative light-induced fluorescence (QLF) and meticulous visual inspection (VI) in detecting non-cavitated caries lesions on occlusal surfaces in young adolescents. It was hypothesized that the respective diagnostic performances of meticulous VI and QLF are similar. Material and methods. The subjects were 34 fifteen-year-old students. Five-hundred-and-seventeen cleaned occlusal surfaces were air-dried and examined using VI. Fluorescence images were captured with QLF equipment and custom software was used to display, store and analyze the images. The area of the lesion (area; mm2), fluorescence loss (ΔF;%) and ΔQ (Area*ΔF; mm2*%) were determined at a QLF threshold of −5%. The presence/absence of non-cavitated lesions was independently recorded with both methods. Results. 78.8% of all untreated surfaces were classified as sound or as having a non-cavitated lesion with both methods uniformly (VI+QLF). On 7.1% of all surfaces a lesion was detected by VI only and on 14.1% by QLF only. All parameters (Area, ΔF, ΔQ) differed significantly between lesions registered with both methods (VI+QLF) and lesions recorded with QLF only. Conclusions. It was concluded that our hypothesis cannot be confirmed. The study shows that QLF detects (1) more non-cavitated occlusal lesions and (2) smaller lesions compared to VI. However, taking into consideration time-consuming image capturing and analysis, QLF is not really practical for use in the dental office.

Fluoride Concentrations and Distribution in Premolars of Children from Low and Optimal Fluoride Areas

We have compared the fluoride (F) concentrations from the enamel surface to the dentino-enamel junction (DEJ), and through dentine to the dentino-pulpal junction (DPJ) in premolars extracted from school children in Chemnitz (former Karl-Marx-Stadt), Germany (F: 1.0 ppm in the water supply), Erfurt, Germany (F: 0.2 ppm in the water supply) and Nagoya, Japan (F: 0.1 ppm in the water supply). In teeth from children in Cheminitz, Erfurt and Nagoya, the profiles of F distribution using an abrasive microsampling technique revealed high F concentrations in the enamel surface, with a substantial decrease towards a plateau in the interior. In dentine the F concentrations were higher than in enamel, and also decreased to a plateau from the DEJ, thereafter increasing considerably towards the DPJ. F concentrations at any depth in the enamel and dentine of teeth from Chemnitz were 2-3 times higher than those in Erfurt and Nagoya. There was no significant difference in F concentrations or distributions between Erfurt and Nagoya. Close to the DEJ in both enamel and dentine as well as the enamel surface and the DPJ side of dentine, higher F concentrations were observed in Chemnitz compared with Erfurt and Nagoya.

An in vitro Comparison between Two Methods of Electrical Resistance Measurement for Occlusal Caries Detection

Because of different measurement techniques and the easier design of the CRM prototype, this in vitro study aimed to compare the diagnostic performance and reproducibility of two electrical methods (Electronic Caries Monitor III, ECM and Cariometer 800, CRM) for occlusal caries detection, and to evaluate the effect of staining/discoloration of fissures on diagnostic performance. Hundred and seventeen third molars with no apparent occlusal cavitation were selected. Six examiners inspected all specimens independently, using the CRM, and a subgroup of 4 using the ECM. Histological validation using a stereomicroscope was performed after hemisectioning. Intra- and interexaminer reproducibility was assessed by Lin’s concordance correlation coefficient (CCC) and Bland and Altman analysis. Diagnostic performance parameters included sensitivity (SE), specificity (SP) and area under the ROC curve (Az). The CCC yielded an intra- and interexaminer reproducibility of 0.69/0.62 (ECM) and of 0.79/0.74 (CRM). The mean intra- and interexaminer 95% range of measurements (range between Bland and Altman limits of agreement) given in percentages of the instrument reading were 67%/65% for the ECM and 28%/33% for the CRM. Az at the D3–4 level was 0.74 (ECM) and 0.78 (CRM). The CRM showed at least equivalent diagnostic performance to the ECM. However, improvement is still desirable. Diagnostic performance appeared to be enhanced in discolored lesions; however, this may be related to sample lesion distribution characteristics.

Are pit and fissure sealants needed in children with a higher caries risk

The aim of this cross-sectional study was to analyse the preventive need of pit and fissure sealants (PFS) in a German population with a relatively high caries risk. The study involved 311 8- to 12-year-old children from the Ennepe–Ruhr District in North Rhine-Westphalia, Germany. Caries experience was scored according to WHO (1997) and ICDAS II criteria. PFS were assessed as intact or partially lost. The mean DFS values amounted to 0.5 for occlusal fissures, 0.2 for palatal/buccal pits and 0.3 for the remaining teeth. Non-cavitated caries lesions were recorded in average on 1.8 occlusal fissures and 1.5 palatal/buccal pits. Sealants were registered on 1.4 occlusal fissures and 0.4 palatal/buccal pits. The descriptive data and the adjusted Poisson regression models revealed that children with at least one fissure sealant are less likely to have decayed fissures or fissures with non-cavitated lesions on their permanent molars. Therefore, PFS are needed and indicated in caries-risk children.

Potential Applications and Limitations ofQuantitative Light-induced Fluorescence in Dentistry

Summary The Quantitative Light-induced Fluorescence (QLF) method provides a fluorescence image of a smooth surface caries lesion, and quantifies that image relative to mineral loss from the lesion and in terms of lesion size. The method may thus be used for quantitative monitoring of mineral changes, regression or progression, in lesions in visually inspectable surfaces within a time period of only a few months. The objectives of this paper were to identify and demonstrate possibilities and limitations of the QLF method for clinical application in dentistry. Results from studies on validation and reliability of QLF are commented on, and examples of confounding factors in clinical application are demonstrated. Longitudinal clinical studies on remineralization of incipient lesions are reviewed. Recommendations for application in clinical dentistry and research are given.